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Laparoscopic Staging of Endometrial Cancer: The Learning Experience

OBJECTIVE: To evaluate our learning-curve experience with laparoscopic management of endometrial carcinoma. METHODS: Retrospective review of our first 125 patients with endometrial cancer who were managed laparoscopically. The patient population was reviewed in a chronological manner, noting patient...

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Autores principales: Melendez, Terry D., Childers, Joel M., Nour, M., Harrigill, Keith, Surwit, Earl A.
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 1997
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015226/
https://www.ncbi.nlm.nih.gov/pubmed/9876646
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author Melendez, Terry D.
Childers, Joel M.
Nour, M.
Harrigill, Keith
Surwit, Earl A.
author_facet Melendez, Terry D.
Childers, Joel M.
Nour, M.
Harrigill, Keith
Surwit, Earl A.
author_sort Melendez, Terry D.
collection PubMed
description OBJECTIVE: To evaluate our learning-curve experience with laparoscopic management of endometrial carcinoma. METHODS: Retrospective review of our first 125 patients with endometrial cancer who were managed laparoscopically. The patient population was reviewed in a chronological manner, noting patient demographics, operative procedure and times, estimated blood loss, hospital stay, complications, and pathology. RESULTS: Overall, the mean age was 68.6 years (range 29-89), the mean weight was 160 pounds (range 97-328), and the mean Quetelet index was 27.8 (range 17.8-56.4). Metastatic disease was discovered in 28.8% (17/59) of patients with grade 2 or 3 lesions. There was no statistically significant variation in any of these parameters throughout the study. Operative times for staging without lymphadenectomy decreased significantly from a mean of 163 minutes to 99 minutes (p<.001). Operative times for staging with lymphadenectomy decreased from a mean of 196 minutes to 128 minutes (p<0.02). Hospital stay decreased from a mean of 3.2 days in the first quarter of our study to 1.8 days (p<.0001). The overall average complication rate of 4% (two enterotomies, two cystotomies, and a transected ureter) did not vary. However, the rate of conversion to laparotomy dropped significantly from 8% (2/25) to 0% (0/100). CONCLUSIONS: We found that operative times and hospital stays for laparoscopic staging of endometrial cancer continued to drop after 125 cases. While the ability to detect metastatic disease and the rate of major complications appear unrelated to length of the operator experience, the conversion rate to laparotomy decreases with operator experience. Learning-curve parameters must be recognized by physicians, patients, and researchers for a host of reasons.
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spelling pubmed-30152262011-02-17 Laparoscopic Staging of Endometrial Cancer: The Learning Experience Melendez, Terry D. Childers, Joel M. Nour, M. Harrigill, Keith Surwit, Earl A. JSLS Scientific Papers OBJECTIVE: To evaluate our learning-curve experience with laparoscopic management of endometrial carcinoma. METHODS: Retrospective review of our first 125 patients with endometrial cancer who were managed laparoscopically. The patient population was reviewed in a chronological manner, noting patient demographics, operative procedure and times, estimated blood loss, hospital stay, complications, and pathology. RESULTS: Overall, the mean age was 68.6 years (range 29-89), the mean weight was 160 pounds (range 97-328), and the mean Quetelet index was 27.8 (range 17.8-56.4). Metastatic disease was discovered in 28.8% (17/59) of patients with grade 2 or 3 lesions. There was no statistically significant variation in any of these parameters throughout the study. Operative times for staging without lymphadenectomy decreased significantly from a mean of 163 minutes to 99 minutes (p<.001). Operative times for staging with lymphadenectomy decreased from a mean of 196 minutes to 128 minutes (p<0.02). Hospital stay decreased from a mean of 3.2 days in the first quarter of our study to 1.8 days (p<.0001). The overall average complication rate of 4% (two enterotomies, two cystotomies, and a transected ureter) did not vary. However, the rate of conversion to laparotomy dropped significantly from 8% (2/25) to 0% (0/100). CONCLUSIONS: We found that operative times and hospital stays for laparoscopic staging of endometrial cancer continued to drop after 125 cases. While the ability to detect metastatic disease and the rate of major complications appear unrelated to length of the operator experience, the conversion rate to laparotomy decreases with operator experience. Learning-curve parameters must be recognized by physicians, patients, and researchers for a host of reasons. Society of Laparoendoscopic Surgeons 1997 /pmc/articles/PMC3015226/ /pubmed/9876646 Text en © 1997 by the Society of Laparoendoscopic Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Melendez, Terry D.
Childers, Joel M.
Nour, M.
Harrigill, Keith
Surwit, Earl A.
Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title_full Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title_fullStr Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title_full_unstemmed Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title_short Laparoscopic Staging of Endometrial Cancer: The Learning Experience
title_sort laparoscopic staging of endometrial cancer: the learning experience
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015226/
https://www.ncbi.nlm.nih.gov/pubmed/9876646
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